Services not routinely covered by Medicare (may be submitted for review)

Home health services

Home IV services

Enteral Nutrition

Hyperbaric oxygen therapy

Mental health/Substance abuse treatment (non-office, outpatient)

Non-emergent ambulance transport

Outpatient therapy (Physical, occupational, speech)

Cardiac and Pulmonary Rehab

Total parenteral services

Genetic testing

The following procedure codes require prior authorization. This list is not all-inclusive. Modifications are made based on coding updates or when the requirement for prior authorization of a service changes. Providers will be given 30 days notice on any additions to services requiring prior authorization.(Last updated 01/19/2015)

Services or procedures considered to be Investigational only will not appear on the prior authorization list. Services considered to be cosmetic only will not appear on the prior authorization list.

If you are already securely logged in and would like to submit your request online click on “Authorization Submission.”To login/enroll in our online “Authorization Submission,” please click hyperlink.

In order to clarify prior authorization requirements for Medicare Advantage members, Blue Cross of Idaho has created the following index of CPT/HCPCS codes. Although prior authorization requirements are currently in place for Medicare Advantage, effective January 1, 2010, providers may utilize the following list to determine what services require review by Blue Cross of Idaho.

Unlisted procedure codes are not prior authorized but reviewed retrospectively from the operative report.

To 'Search' for a Code: Hold CTRL key, type the letter F for Find Dialogue Box, Type in code and hit enter (make sure you are the beginning of the page first)

Click on the Section Name if you wish to view descriptions for listed CPT/HCPCS codes